Provider Demographics
NPI:1104051507
Name:CHERN, ANNIE BERTHA-CHAO (MD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:BERTHA-CHAO
Last Name:CHERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 OCONNOR DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1633
Mailing Address - Country:US
Mailing Address - Phone:408-995-5453
Mailing Address - Fax:
Practice Address - Street 1:455 OCONNOR DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1633
Practice Address - Country:US
Practice Address - Phone:408-995-5453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine